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Berlin C, Andrieux G, Menzel M, Stöger GJ, Gengenbach A, Schäfer L, Hillebrecht HC, Kesselring R, Le UT, Fichtner-Feigl S, Holzner PA. Long-Term Outcome After Resection of Hepatic and Pulmonary Metastases in Multivisceral Colorectal Cancer. Cancers (Basel) 2024; 16:3741. [PMID: 39594697 PMCID: PMC11592306 DOI: 10.3390/cancers16223741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Revised: 10/28/2024] [Accepted: 11/02/2024] [Indexed: 11/28/2024] Open
Abstract
BACKGROUND/OBJECTIVES Colorectal cancer (CRC) with hepatic (CRLM) and pulmonary metastases (CRLU) presents a significant clinical challenge, leading to poor prognosis. Surgical resection of these metastases remains controversial because of limited evidence supporting its long-term benefits. To evaluate the impact of surgical resection of both hepatic and pulmonary metastases on long-term survival in patients with multivisceral metastatic colorectal cancer, this retrospective cohort study included 192 patients with UICC stage IV CRC treated at a high-volume academic center. METHODS Patients were divided into two groups: those who underwent surgical resection of both hepatic and pulmonary metastases (n = 100) and those who received non-surgical treatment (n = 92). Propensity score matching was used to adjust for baseline differences. The primary outcome was overall survival (OS). RESULTS Unadjusted analysis showed a significant OS benefit in the surgical group (median OS: 6.97 years) compared with the conservative group (median OS: 2.17 years). After propensity score matching, this survival advantage persisted (median OS: 5.58 years vs. 2.35 years; HR: 0.3, 95% CI: 0.18-0.47, p < 0.0001). CONCLUSIONS Surgical resection of hepatic and pulmonary metastases in multivisceral metastatic CRC significantly improves long-term survival, supporting an aggressive surgical approach in selected patients.
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Affiliation(s)
- Christopher Berlin
- Department of General and Visceral Surgery, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany; (M.M.); (G.J.S.); (A.G.); (L.S.); (H.C.H.); (R.K.); (S.F.-F.)
- German Cancer Consortium (DKTK) Partner Site, 79106 Freiburg im Breisgau, Germany
- IMMediate Advanced Clinician Scientist-Program, University of Freiburg, 79106 Freiburg im Breisgau, Germany
| | - Geoffroy Andrieux
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center–University of Freiburg, 79106 Freiburg im Breisgau, Germany;
| | - Magdalena Menzel
- Department of General and Visceral Surgery, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany; (M.M.); (G.J.S.); (A.G.); (L.S.); (H.C.H.); (R.K.); (S.F.-F.)
| | - Gabriel J. Stöger
- Department of General and Visceral Surgery, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany; (M.M.); (G.J.S.); (A.G.); (L.S.); (H.C.H.); (R.K.); (S.F.-F.)
| | - Andreas Gengenbach
- Department of General and Visceral Surgery, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany; (M.M.); (G.J.S.); (A.G.); (L.S.); (H.C.H.); (R.K.); (S.F.-F.)
| | - Luisa Schäfer
- Department of General and Visceral Surgery, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany; (M.M.); (G.J.S.); (A.G.); (L.S.); (H.C.H.); (R.K.); (S.F.-F.)
| | - Hans C. Hillebrecht
- Department of General and Visceral Surgery, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany; (M.M.); (G.J.S.); (A.G.); (L.S.); (H.C.H.); (R.K.); (S.F.-F.)
| | - Rebecca Kesselring
- Department of General and Visceral Surgery, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany; (M.M.); (G.J.S.); (A.G.); (L.S.); (H.C.H.); (R.K.); (S.F.-F.)
- German Cancer Consortium (DKTK) Partner Site, 79106 Freiburg im Breisgau, Germany
| | - Uyen-Thao Le
- Department of Thoracic Surgery, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany
| | - Stefan Fichtner-Feigl
- Department of General and Visceral Surgery, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany; (M.M.); (G.J.S.); (A.G.); (L.S.); (H.C.H.); (R.K.); (S.F.-F.)
| | - Philipp A. Holzner
- Department of General and Visceral Surgery, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany; (M.M.); (G.J.S.); (A.G.); (L.S.); (H.C.H.); (R.K.); (S.F.-F.)
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White MJ, Jensen EH, Brauer DG. A Review of Resection and Surgical Ablation for Primary and Secondary Liver Cancers. Semin Intervent Radiol 2023; 40:536-543. [PMID: 38274223 PMCID: PMC10807965 DOI: 10.1055/s-0043-1777747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
The surgical management of primary and secondary liver tumors is constantly evolving. Patient selection, particularly with regard to determining resectability, is vital to the success of programs directed toward invasive treatments of liver tumors. Particular attention should be paid toward determining whether patients are best served with surgical resection or ablative therapies. A multidisciplinary approach is necessary to provide optimal care to patients with liver malignancy.
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Affiliation(s)
- McKenzie J. White
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Eric H. Jensen
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - David G. Brauer
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
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Sturesson C, Engstrand J, Strömberg C. Reply to: The cohort data in the full pulmonary Metastasectomy in colorectal cancer study: Comment on Engstrand et al. Eur J Surg Oncol 2022; 48:1874. [DOI: 10.1016/j.ejso.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022] Open
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Treasure T, Williams NR, Macbeth F. The cohort data in the full pulmonary metastasectomy in colorectal cancer study: Comment on Engstrand et al. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1869-1870. [PMID: 35525726 DOI: 10.1016/j.ejso.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, UK.
| | - Norman R Williams
- Surgical and Interventional Trials Unit, University College London, UK
| | - Fergus Macbeth
- Centre for Trials Research, Cardif University, Cardiff, UK
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